A 27-year-old G3P0L0 has had two consecutive first-trimester losses at 8 and 10 weeks. She also had a documented left leg deep vein thrombosis last year. Lupus anticoagulant and anticardiolipin IgG are positive on testing repeated 12 weeks apart. What is the best management in her next pregnancy?
- A Low-dose aspirin 75 mg daily alone
- B Prophylactic low molecular weight heparin plus low-dose aspirin from early pregnancy ✓
- C Oral prednisolone 40 mg daily throughout pregnancy
- D Monthly intravenous immunoglobulin infusions
Correct answer: B. Prophylactic low molecular weight heparin plus low-dose aspirin from early pregnancy
Explanation
Obstetric antiphospholipid syndrome with recurrent pregnancy loss is treated with low-dose aspirin plus prophylactic LMWH, which raises live birth rates to around 70 percent. Aspirin alone is inadequate when vascular events coexist. Prednisolone is reserved for refractory disease because it increases gestational diabetes and preterm birth, and IVIG has shown no benefit over heparin and aspirin.
Reference: Williams Obstetrics, 25th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.